Studies have documented the increasing size of the population with disabilities, the rapid increase in the use of AT by the individuals with disabilities, disparity in the provision of AT devices, and factors influencing non-use of AT devices. What is lacking is more in depth information about the efficacy, distribution, and impact of AT devices. Little is known about the outcomes of the decision process clinicians engage in when prescribing ATDs, i.e. How many devices are being prescribed and to whom? How often? At what cost? This research team has found significant geographic variation in the provision of AT devices by the VHA that cannot be fully explained by veteran factors such as demographics, diagnosis, and severity of disability. "Technology that gives veterans back functional independence" (http://www.research.va.gov/) is a focus of the VHA. Also important is consideration of how veterans will access the technology. Past research as shown variation in the provisionof ATDs that can not be accounted for by veteran need. The proposed research will investigate VHA system and process factors that can effect AT device provision patterns. Results of the proposed study will provide evidence that can be used to develop guidelines to insure that access to the technology is equitable for all veterans including those residing in rural areas. This will be a retrospective, national, population-based study of veterans who had their first stroke during FY 2006-07. Data will be acquired from several national VA databases. The specific aims of the proposed research are: (1) To determine the impact of VHA "structure" factors on "process" and veteran "outcome" factors and (2) To determine the impact of VHA "process" factors on the veteran "outcome" - receipt of ATD(s). Using the Structure Process Outcomes conceptual model, the Aim 1 will use multivariate regression analyses to investigate the relationship between: (1a) VHA staffing and facility complexity, AT assessments administered, and patient training in use of AT and (1b) VHA staffing and facility types and and device provision patterns. Aim 2 will use Poisson regression analyses to investigate the relationship between the number of AT assessments administered and times training in use of AT is provided and device provision patterns. The long terms objectives are: (1) To develop evidence-based AT/prosthetic provision guidelines across diagnoses and levels of disability and types of devices, e.g. mobility devices, artificial limbs, etc. and (2) To develop programs to evaluate the effectiveness of the guidelines. PUBLIC HEALTH RELEVANCE: Narrative Assistive technology can improve veterans'independence and quality of their lives. This study will investigate how many devices are being prescribed and to whom. The results of this study can assist in providing information for the appropriate use of resources with the intent of making assistive technology equally available to all veterans.